Severity of acute gallstone pancreatitis in patients with pancreas divisum

The presence of pancreas divisum may reduce the severity of acute gallstone pancreatitis (AGP), as stone impaction at the major papilla only affects the ventral pancreas.

The severity of AGP was compared retrospectively in patients with and without pancreas divisum. Acute gallstone pancreatitis was defined by clinical, biological, radiological, and endoscopic features. Thirteen patients with AGP and pancreas divisum were identified among those presenting with AGP between 1989 and 2000. Pancreas divisum patients were compared to 39 control individuals with AGP and conjugate pancreas. All patients underwent biliary sphincterotomy. Levels of serum amylases, lipases, C-reactive protein (CRP), and white blood cells (WBC) were compared in patients with AGP and pancreas divisum and in control individuals before sphincterotomy. The severity of pancreatitis was assessed on the basis of CRP, Ranson's score, computed tomography, the need for intensive care and drainage of collections or necrosis, duration of hospitalization, and mortality.

Patients with AGP and pancreas divisum had a lower severity grade at CT scanning than control individuals ( P = 0.005), a shorter hospitalization period (5 +/- 1.9 vs. 11.6 +/- 1.6 nights; P = 0.032), and lower mortality (none of 13 vs. four of 39; P = 0.048). Serum amylases and lipases, WBC, and Ranson's score tended to be lower in patients with AGP and pancreas divisum, but the difference was not significant in comparison with control individuals.

Acute gallstone pancreatitis is less severe in patients with pancreas divisum than in those with a conjugate pancreas.